Remote Medical Claims Analyst Jobs (NOW HIRING)

Peoplease is a leading Professional Employer Organization (PEO) providing solutions to small and medium-sized businesses in the blue and gray-collar industries. We enable our clients and partners to achieve their aspirations by offering world-class service and administrative solutions in payroll, human resources, benefits, and risk management. At Peoplease, we foster a culture of inclusion and belonging, driven by our core values: Engagement, Integrity, Tenacity, Curiosity, Happiness, and a Service-obsessed mindset.

Peoplease is looking for a qualified Workers' Compensation Claims Analyst to join our team. The purpose of the Claims Department is to manage a caseload of complex workers’ compensation insurance claims for our client’s employees. The Workers' Compensation Claims Analyst will help the Claims Department by determining compensability, monitoring reserves, and aggressively negotiating settlement of claims. Additionally, this position is accountable for the quality of claim services as perceived by Peoplease clients and within our corporate claim standards.

An ideal candidate will have the ability to manage and execute the coordination of multiple projects within required timeframes and expectations; demonstrated excellence in communication skills; be able to inform both orally and in writing; working knowledge of Microsoft Office products. Demonstrate the ability to perform detail-oriented tasks; interact, coordinate, follow up, and effectively communicate with WC team members, regional teams, Senior Management, and Third-Party Administrators.

Candidate must be a self-starter with the ability to function as a remote employee with a Pacific Standard Time (PST) / Mountain Standard Time (MST) work schedule in a distributed work team.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

•  Manage a caseload of WC claims in multiple jurisdictions which may be outside the assigned region
• Investigate and monitor claims in accordance with established claims handling procedures using company guidelines
• Manage all open work comp claims for assigned multistate territories (Approx. 175-200 claims) with a mix of Med Only and indemnity/loss time
• Give recommendations to carrier/TPA for ways to help lower the cost of the claims as well as getting the claim closed
• Handle all litigation requests from attorneys
• Review and evaluate settlement authority, reserve requests within assigned authority levels
• Assess and monitor subrogation claims for resolution
• Delivery of quality claim oversight to clients
• Participate in QBR’s and client claim reviews
• Guide and educate clients on proper claim reporting
• Review medical, legal and miscellaneous file documentation to determine if reasonable and related to the ongoing claim
• Liaison between the client and insurance carrier/TPA
• Assist in selection and supervision of defense attorneys
• Prepare reports detailing claims, payments and reserves
• Prepare and participate in claims reviews
• Compliance with Service Commitments as established by team
• Multitask between internal RMIS Systems – Carrier/TPA/Peoplease
• Performs other duties as assigned within scope of role

• 3+ years of WC claim experience and/or TPA claims oversight experience required
• 8am-5pm PST or MST work schedule
• PEO or Staffing WC claims oversight experience a plus
• Additional WC claims management experience in multiple jurisdictions a plus
• Ideal candidate will have experience working as a remote employee in a distributed work team
• Must be detail oriented
• Must be able to meet deadlines
• Proficient with Microsoft Office products

• Be part of an innovative and growth-oriented company in the PEO industry.
• Opportunity to drive meaningful impact and lead a high-performing team.
• Competitive salary and benefits package.

The role requires regular communication and occasional travel to support the distributed workforce. The role will primarily function indoors but may involve working in varying temperatures or outdoor environments as needed.

Peoplease will never:

• Send an unsolicited job offer without you submitting an application and interviewing
• Ask you to pay fees, purchase equipment, or provide banking details to secure a position

When in doubt, verify. Contact our HR team directly at MyHR@peoplease.com before responding to any suspicious communication.